Trial reportPLoS medicine2023
A nutritional biomarker score of the Mediterranean diet and incident type 2 diabetes: Integrated analysis of data from the MedLey randomised controlled trial and the EPIC-InterAct case-cohort study.
Trial report in PLoS medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 1 synthesis or guideline pooled it, 28 citations in OpenAlex.
- A bibliometric analysis of the Mediterranean diet in metabolic syndrome (2015-2025).Frontiers in nutrition · 2026Pooled it
- Carotenoids in the Context of the Mediterranean Dietary Pattern: From Food Matrix and Bioavailability to Biomarkers and Human Health.Antioxidants (Basel, Switzerland) · 2026Review
- Mediterranean Dietary Pattern in Type 2 Diabetes Management: Pathways and Clinical Evidence.Biomedicines · 2026Review
- Associations between dietary patterns and diabetes in patients with acute pancreatitis: a cross-sectional analysis from the DREAM study.Nutrition journal · 2026Observational
- A narrative review of dietary patterns in cardiovascular-kidney-metabolic syndrome.Frontiers in nutrition · 2026Review
- The Role of the Gut Microbiome in Type 2 Diabetes Mellitus.International journal of molecular sciences · 2025Review
- Association between dietary patterns and cardiovascular mortality in patients with metabolic dysfunction-associated steatotic liver disease.Endocrine · 2025Article
- The association of the planetary health diet with type 2 diabetes incidence and greenhouse gas emissions: Findings from the EPIC-Norfolk prospective cohort study.PLoS medicine · 2025Article
- Article
- Integrated strategies for type 2 diabetes prevention: The role of diet and exercise.AIMS public health · 2025Review
- Proteomic scores and dietary patterns.Nature food · 2025Article
- The interplay between diet and the gut microbiome: implications for health and disease.Nature reviews. Microbiology · 2024Review
- Relationship between diabetic peripheral neuropathy and adherence to the Mediterranean diet in patients with type 2 diabetes mellitus: an observational study.Journal of endocrinological investigation · 2024Observational
- Impact of Rice Bran Oil Emulsified Formulation on Digestion and Glycemic Response to Japonica Rice: An In Vitro Test and a Clinical Trial in Adult Men.Foods (Basel, Switzerland) · 2024Article
- Towards nutrition with precision: unlocking biomarkers as dietary assessment tools.Nature metabolism · 2024Review
- Impact of a short-term Mediterranean diet intervention on plasma metabolites: a pilot study.Metabolomics : Official journal of the Metabolomic Society · 2024Article
- MicroRNAs and the Mediterranean diet: a nutri-omics perspective for lung cancer.Journal of translational medicine · 2024Review
- [Research Progress of the Effect of Mediterranean Diet on the Correlation of Lung Cancer].Zhongguo fei ai za zhi = Chinese journal of lung cancer · 2024Review
- Nutrition at the Intersection between Gut Microbiota Eubiosis and Effective Management of Type 2 Diabetes.Nutrients · 2024Review
- Article
Corrections and comments
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Authors and funding
34 authors at 20 institutions in 13 countries.
Funding
Abstract
backgroundSelf-reported adherence to the Mediterranean diet has been modestly inversely associated with incidence of type 2 diabetes (T2D) in cohort studies. There is uncertainty about the validity and magnitude of this association due to subjective reporting of diet. The association has not been evaluated using an objectively measured biomarker of the Mediterranean diet. METHODS AND
findingsWe derived a biomarker score based on 5 circulating carotenoids and 24 fatty acids that discriminated between the Mediterranean or habitual diet arms of a parallel design, 6-month partial-feeding randomised controlled trial (RCT) conducted between 2013 and 2014, the MedLey trial (128 participants out of 166 randomised). We applied this biomarker score in an observational study, the European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study, to assess the association of the score with T2D incidence over an average of 9.7 years of follow-up since the baseline (1991 to 1998). We included 22,202 participants, of whom 9,453 were T2D cases, with relevant biomarkers from an original case-cohort of 27,779 participants sampled from a cohort of 340,234 people. As a secondary measure of the Mediterranean diet, we used a score estimated from dietary-self report. Within the trial, the biomarker score discriminated well between the 2 arms; the cross-validated C-statistic was 0.88 (95% confidence interval (CI) 0.82 to 0.94). The score was inversely associated with incident T2D in EPIC-InterAct: the hazard ratio (HR) per standard deviation of the score was 0.71 (95% CI: 0.65 to 0.77) following adjustment for sociodemographic, lifestyle and medical factors, and adiposity. In comparison, the HR per standard deviation of the self-reported Mediterranean diet was 0.90 (95% CI: 0.86 to 0.95). Assuming the score was causally associated with T2D, higher adherence to the Mediterranean diet in Western European adults by 10 percentiles of the score was estimated to reduce the incidence of T2D by 11% (95% CI: 7% to 14%). The study limitations included potential measurement error in nutritional biomarkers, unclear specificity of the biomarker score to the Mediterranean diet, and possible residual confounding.
conclusionsThese findings suggest that objectively assessed adherence to the Mediterranean diet is associated with lower risk of T2D and that even modestly higher adherence may have the potential to reduce the population burden of T2D meaningfully.
trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000602729 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363860.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.